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Box 8 Methods of administering rituximab

From: French recommendations for the management of systemic necrotizing vasculitides (polyarteritis nodosa and ANCA-associated vasculitides)

Precautions
Vaccination of patients against influenza and pneumococcus can be useful
It is also useful for preventing pneumocystis systematically throughout the entire treatment and in the following months (practically speaking, until immunological reconstitution)
Premedication
Administer about 60 min prior to starting each infusion of rituximab:
Methylprednisolone (Solu-Medrol®): 100 mg in a vial of 50 ml of glucose 5% solution to run in 10 min
Paracetamol: 1 g by direct intravenous injection
Dexchlorpheniramine (Polaramine®): 5 mg by direct intravenous injection
Induction treatment
Rituximab induction treatment is administered by infusion at a dose of 375 mg/m2 on days 1, 7, 14, and 21, after premedication performed prior to each infusion
First infusion: it is recommended to start infusion at a rate of 50 mg/h; after the first 30 min, the infusion rate may be increased in steps of 50 mg/h every 30 min, until reaching a maximum rate of 400 mg/h
Second infusion: initial rate should be 100 mg/h, then increased in steps of 100 mg/h every 30 min, until reaching a maximum rate of 400 mg/h
Maintenance treatment
Once remission has been achieved, infusion of 500 mg of rituximab is administered on days 1 and 15, then every 6 months
 
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